European Comparative Effectiveness Research on Internet-based Depression
Treatment
Grant Agreement No: 603098
USER GUIDE - SEMI MARKOV MODEL
EXCEL FILE DEVELOPPED FOR THE ECOMPARED STUDY
To all the participants and stakeholders of the E-Compared study,
To all the decision makers wishing to implement internet-based depression treatment in their
own country,
This guide aims to serve as a tool to help you navigate the generic Markov model which was
developed in Excel.
The model includes several spreadsheets that are organized by clearly labeled tabs. Each
spreadsheet tab is dependent on one another, thus it is important not to delete or modify
the tabs, which will alter the final computed results of the model or stop the model from
running properly. Results are provided in the form of incremental cost-effectiveness ratios
(ICERs) at five years using two effectiveness criteria and three cost scenarios, estimating a
cost per QALY gained and a cost per day spent in remission or recovery from the perspective
of the national health insurance only, the perspective of all health care payers and from the
societal perspective.
Below you will find a more detailed description of the contents of the Excel file.
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USER GUIDE E-COMPARED STUDY - 07/03/2016
European Comparative Effectiveness Research on Internet-based Depression
Treatment
Grant Agreement No: 603098
CONTENTS OF THE EXCEL FILE: Tab descriptions
The main tabs of interest to populate the generic Markov model are the following:
« Read First » is the main interface of the model. It is where you, the user, are given several inputs to
choose from before running the model (treatment setting, country-specific treatment as usual, unit
costs, cost-effectiveness parameters).
« Structure » includes a representation of the semi Markov model structure with all possible
transitions between health states.
« TAU Model » and « Blended Model » are two separate tabs that correspond to the model inputs
for the different treatment arms (treatment as usual and blended therapy). They depend on your
choices in the main interface (« Read First ») and illustrate the transition probabilities that change
yearly for each health state, as well as costs for the three scenarios and treatment effectiveness with
QALYS and time spent in remission or recovery.
« Results TAU » and « Results Blended », likewise, show the results of each treatment arm
simulated at a five year time horizon, calculated from the « TAU Model » and « Blended Model »
tabs.
« Results ICERs » displays the incremental cost-effectiveness ratios calculated from the « Results
TAU » and « Results Blended » tabs and comparing both treatments with the two effectiveness
criteria and the three cost scenarios.
« Other inputs »: this tab is reached from « Read First » tab. This is where you have the possibility to
enter country-specific data i.e. unit costs for the different healthcare resources, severity levels of
patients with depression and other parameters according to the characteristics of your country.
The tabs described above are not exhaustive of all the tabs present in the Excel file. Other tabs
include country-specific results of treatments’ effectiveness and costs for the countries who
participated in the E-Compared trial. Those tabs cannot be altered.
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USER GUIDE E-COMPARED STUDY - 07/03/2016
European Comparative Effectiveness Research on Internet-based Depression
Treatment
Grant Agreement No: 603098
USER GUIDE - How to use the generic Markov model Excel file
In this section, you will find instructions on how to use the semi Markov generic model in the Excel
file provided.
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USER GUIDE E-COMPARED STUDY - 07/03/2016
European Comparative Effectiveness Research on Internet-based Depression
Treatment
Grant Agreement No: 603098
Before applying the instructions, please make sure to be aware of how depression is treated in your
country, and how the internet-based depression treatment will be administered.
The basic steps to operate the model are as follows:
1. Click on the « Read First » tab. This spreadsheet is the main interface of the model. It is
organized in three main parts:
a. Regarding internet-based depression treatment: will it be in a primary care or
secondary care setting?
First you must select the appropriate health care setting for where internet based treatment
is administered. Click next to the button that indicates Choose here, there will be a
dropdown menu that provides two options, "primary care" or "secondary care". Please
choose the appropriate option that corresponds to your country.
b. Regarding the treatment of depression: which of the following descriptions is closer
to the situation in the country being considered?
Once the selected health care setting is chosen, you have to choose the depression
treatment strategy that most closely resembles usual care in your country. There are
descriptions of each participating country’s depression treatment on the left. Click on the
appropriate treatment option from the dropdown menu next to the second Choose here
button.
c. What are the unit costs for each resource and the coverage by the national health
insurance in your country?
In this section you have the choice to enter unit costs for your country. If you wish to provide
this information select Yes from the dropdown menu, and then click on the Add unit costs
button, which will direct you to a supplementary spreadsheet titled « Other inputs », where
you will need to input the unit costs manually.
If you prefer not to add the unit costs of your own country, select No in the dropdown menu.
The default costs for the country of your chosen usual care treatment will serve as inputs in
the model.
d. Changing the model input parameters
You may change the discount rate for costs and/or effectiveness along with the costeffectiveness threshold. If the ones currently in use in the model do not reflect your country’s
recommendations for health economics evaluations, click on the Change settings button in
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USER GUIDE E-COMPARED STUDY - 07/03/2016
European Comparative Effectiveness Research on Internet-based Depression
Treatment
Grant Agreement No: 603098
the « Read First » tab. You also have the possibility of changing the distribution of patients in
each depression severity level at baseline.
Once you have filled in all of the fields in the « Read First » tab the model will run automatically.
2. Results
Once you have run the model you can click on the three Results tabs. Results are displayed in
separate tabs for each treatment group: « Results TAU » and « Results Blended ». In the « Results
ICERs » tab, comparisons between the two treatments are performed. It includes the incremental
cost-effectiveness ratios for the two effectiveness criteria and for the three cost scenarios, as well as
summary graphics of total costs and QALYS gained at 5 years based on treatment groups.
3. Country-specific tabs
Within the Excel file there are country-specific tabs for the eight countries participating in the ECompared trial. Those tabs include for both treatment arms:
- Unit costs
- And for each health state:
o Resources used
o Associated costs
o Transition probabilities to other health states
o Effectiveness criteria
Please note that for the blended treatment arm, effectiveness and transition probabilities are pooled
estimates from several countries based on the treatment setting (primary care vs. secondary care).
Reminder: As mentioned previously, each spreadsheet tab is dependent on one another, thus it
is important not to delete or modify the tabs as it would alter the final computed results of
the model or stop it from running.
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USER GUIDE E-COMPARED STUDY - 07/03/2016